Wednesday, 28 January 2015

Finally, Justice for Suhair al-Bata'a

In one of our first blog posts, we lamented the decision of an Egyptian court to acquit the perpetrator of the botched circumcision that lead to the death of 13-year old Suhair al-Bata'a. How could an entire judicial system overlook the death of a minor, and by so doing, uphold a tradition that it had outlawed on the basis of another minor's death? How could it fail to implement any sanctions when 700 USD had cost the life of a child? In a reversal of fortunes however, the Egyptian courts conducted a retrial of both the doctor and the father of Suhair who had been responsible for the chain of events that led to her demise. The court convicted Dr. Raslan Fadl of manslaughter and sentenced him to two years in prison for the offence and three months for performing the genital surgery. His clinic will be closed for a year. Suhair's father was handed a three-month suspended sentence. Advocates against FGM/C in Egypt and around the world are hailing this development as an important stride in the campaign against the practice, especially in a country that has a prevalence rate of 91.1%. Indeed, the earlier acquittal raised questions about the effectiveness of instituting legislation against the practice. However, national laws against FGM were not encouraged as the only intervention for curbing FGM, but as an attendant to the ongoing efforts of discouraging the practice.

Another FGM/C trial is now ongoing in the UK, where Dr Dhanuson Dharmasena has been accused of performing a reinfibulation in 2012. Reinfibulation is "the practice of re-suturing and thereby creating an infibulation following a procedure in which the infibulation has been partially or fully opened, most commonly to facilitate childbirth" (WHO 2010). In this case, Dr. Dharmasena did not leave the infibulation open as has been recommended as best practice during post delivery care for women who have undergone FGM. Reinfibulating one's patient not only constitutes an offence under the UK 2003 Female Genital Mutilation Act, but it also leads to additional physical and psychological trauma for the woman. It amounts to performing FGM/C all over again. According to Dr. Dharmasena, he was unaware that his actions counted as an offence under the law. He maintains that he was simply following the wishes of patient. While we are yet to see what the UK will conclude on this case, we can consider what this case reveals about the state of healthcare and its relationship to FGM/C.

Dr. Dhanuson Dharmasena
Image Source:
Healthcare providers need to be educated on FGM/C. In today's world, and especially in countries where a significant number of the population practice FGM/C, doctors cannot afford to remain ignorant about FGM/C. Indeed, such ignorance can only lead to substandard and insensitive care for pregnant women who are circumcised. Countries need to develop and fully implement training protocols on pre and post-delivery care for women who have undergone FGM/C. Such care should be done within an atmosphere that fosters respect for the pregnant mother, while explaining why a reinfibulation will not be performed i.e it may lead to physical, psychosexual and obstetric complications. Individuals trust their lives to doctors, and doctors should never abuse this trust, whether for financial gain or out of ignorance.

****Read our other blogpost on doctors and FGM/C. 

Monday, 19 January 2015

The Battle Over Her Body

Late last year, a group of Samburu elders met together to deliberate on insecurity in their community. While discussing interventions that they would initiate, the group declared that FGM/C remained an important cultural practice that needs to continue. One man who was later interviewed affirmed the position of the group, going on to say that any child born of an uncircumcised woman would be killed. Covered by the Kenyan media, the encounter raised serious questions about the extent of FGM/C practice in the community. Even more worrying was the silence of both male and female leaders in the area who did not immediately condemn the stance of the 3,000 men present. However, the most shocking revelation was the callous manner in which the men insisted on the killing of children born to uncircumcised women.

Samburu Elders Endorse FGM as a Critical Cultural Rite.
Source: NTV

The statement may reveal the role of FGM/C in brokering access to sex and reproduction, or perhaps ensuring that children could only be born within a marriage relationship. Nevertheless, such cultural explanations have no place today. Instead, they underscore a double standard. The Samburu do not culturally value virginity, and uncircumcised girls are encouraged to have sexual relations with the Samburu morans. Such fraternizing can only increase the likelihood of an uncircumcised girl falling pregnant. Furthermore, the statement highlights how the Samburu woman's body has become a site for exploitation; for the fulfillment of men's vision for Samburu women. It's a statement reifying one of the feminist theories that has been applied to FGM/C - FGM/C as a sign of patriarchy and control of women's sexuality. 

Indeed, FGM/C, while practiced on women by women, is supported within a societal and cultural framework that includes men. Samburu girls not only undergo FGM/C, but a number are also subjected to early marriage, especially in the marginal areas. Advocating against FGM/C is thus not only mitigating physical and psycho-sexual consequences on the female body, but it's also encouraging the community to allow girls to own their bodies and their futures. It's welcoming women into the conversation around sex and reproduction that culture often deems to be the preserve of men. It's allowing our communities to take part in global conversations on women's rights and liberties, even while maintaining the cultural aspects that we collectively esteem. 

Friday, 16 January 2015

Should Doctors Collect FGM/C Data during Antenatal Care?

Doctors need to step up the fight against FGM/C. FGM/C impacts women during child birth, leading to obstetric complications like prolongation of second stage labour, tears and subsequently fistula or episiotomy so as to remove the obstruction. If the obstetrician is caught unaware, he or she will resort to performing a C-section on the mother. Others include perineal tears and infections, fetal distress, cerebral palsy and even still birth. Hence, doctors should record histories of women during antenatal visits. 

At the hospital, doctors are at the point of contact with possible victims of FGM/C and can easily counsel and guide them given their training on the matter rather than waiting to the point of emergency. Kenyan medics should include FGM/C questions and facts in the antenatal cards and books recording a mother’s history. Alternatively, FGM/C prone areas can have a register and questions asked while taking history. These records would not only give us information on what an area is experiencing but also give much needed data on the trend of this scourge. This will in turn make doctors aware so as to track antenatal complications in their area and subsequently see how they can improve the lives of mothers and children. 

Because FGM/C is a generational trend, doctors and clinicians should be well equipped with information and able to advice these women, thus creating more awareness on FGM/C complications. We need more ambassadors, especially medical practitioners, as the social dynamics have proven that people now go to doctors to perform FGM/C hence the term "medicalization of FGM/C." To curb this trend, the doctors should be armed with both socio-cultural and medical information counseling them against performing the cut. After all, no one would want to be caught uninformed, as their information will then lose credibility.